{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T08:24:44Z","timestamp":1792225484513,"version":"4.4.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T00:00:00Z","timestamp":1619568000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T00:00:00Z","timestamp":1619568000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003407","name":"Ministero dell\u2019Istruzione, dell\u2019Universit\u00e0 e della Ricerca","doi-asserted-by":"publisher","award":["PRIN 2007 prot. 2007WEJLZB and PRIN 2009 prot. 20092ZELR2"],"award-info":[{"award-number":["PRIN 2007 prot. 2007WEJLZB and PRIN 2009 prot. 20092ZELR2"]}],"id":[{"id":"10.13039\/501100003407","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005010","name":"Associazione Italiana per la Ricerca sul Cancro","doi-asserted-by":"publisher","award":["IG 2011\/11855"],"award-info":[{"award-number":["IG 2011\/11855"]}],"id":[{"id":"10.13039\/501100005010","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Environ Health"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The International Agency for Research on Cancer (IARC) recently classified glyphosate, the most used herbicide worldwide, as a probable human carcinogen. We inquired into the association between occupational exposure to glyphosate and risk of lymphoma subtypes in a multicenter case-control study conducted in Italy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>The Italian Gene-Environment Interactions in Lymphoma Etiology (ItGxE) study took place in 2011\u201317 in six Italian centres. Overall, 867 incident lymphoma cases and 774 controls participated in the study. Based on detailed questionnaire information, occupational experts classified duration, confidence, frequency, and intensity of exposure to glyphosate for each study subject. Using unconditional regression analysis, we modelled risk of major lymphoma subtypes associated with exposure to glyphosate adjusted by age, gender, education, and study centre.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Very few study subjects (2.2%) were classified as ever exposed to glyphosate. Risk of follicular lymphoma (FL) was elevated 7-fold in subjects classified as ever exposed to glyphosate with medium-high confidence, 4.5-fold in association with medium-high cumulative exposure level, 12-fold with medium-high exposure intensity, and 6-fold with exposure for 10\u2009days or more per year. Significant upward trends were detected with all the exposure metrics, but duration. The overall <jats:italic>p<\/jats:italic>-value for an upward trend with four independent metrics was 1.88\u2009\u00d7\u200910<jats:sup>\u2212\u20094<\/jats:sup>. There was no association with risk of lymphoma (any subtype), Non Hodgkin Lymphoma, B-cell lymphoma, or the major lymphoma subtypes other than FL.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Our findings provide limited support to the IARC decision to classify glyphosate as Group 2A human carcinogen.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12940-021-00729-8","type":"journal-article","created":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T16:09:35Z","timestamp":1619626175000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Occupational exposure to glyphosate and risk of lymphoma:results of an Italian multicenter case-control study"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8120-2103","authenticated-orcid":false,"given":"Federico","family":"Meloni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giannina","family":"Satta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Padoan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Montagna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Pilia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Argiolas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Piro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corrado","family":"Magnani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Gambelunghe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Muzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni Maria","family":"Ferri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Vimercati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Zanotti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aldo","family":"Scarpa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariagrazia","family":"Zucca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"De Matteis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcello","family":"Campagna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Miligi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluigi","family":"Cocco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,4,28]]},"reference":[{"issue":"1","key":"729_CR1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s12302-016-0070-0","volume":"28","author":"CM Benbrook","year":"2016","unstructured":"Benbrook CM. Trends in glyphosate herbicide use in the United States and globally. Environ Sci Eur. 2016;28(1):3. https:\/\/doi.org\/10.1186\/s12302-016-0070-0.","journal-title":"Environ Sci Eur"},{"issue":"5","key":"729_CR2","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1002\/ps.4652","volume":"74","author":"SO Duke","year":"2018","unstructured":"Duke SO. The history and current status of glyphosate. Pest Manag Sci. 2018;74(5):1027\u201334. https:\/\/doi.org\/10.1002\/ps.4652.","journal-title":"Pest Manag Sci"},{"key":"729_CR3","first-page":"1","volume-title":"Glyphosate resistance in crops and weeds: history, development, and management","author":"GM Dill","year":"2010","unstructured":"Dill GM, Sammons RD, Feng PCC, Kohn F, Kretzmer K, Mehrsheikh A, et al. Chapter 1: Glyphosate: Discovery, Development, Applications and Properties. In: Nandula VK, editor. Glyphosate resistance in crops and weeds: history, development, and management. Hoboken: Wiley; 2010. p. 1\u201333."},{"key":"729_CR4","first-page":"321","volume-title":"Some organophosphate insecticides and herbicides. Glyphosate","author":"International Agency for research on Cancer","year":"2017","unstructured":"International Agency for research on Cancer. IARC Monographs on the Evaluation of the Carcinogenic Risks to Humans. In: Some organophosphate insecticides and herbicides. Glyphosate, vol. 112. Lyon: IARC; 2017. p. 321\u2013412."},{"issue":"9","key":"729_CR5","doi-asserted-by":"publisher","first-page":"e11","DOI":"10.1136\/oem.60.9.e11","volume":"60","author":"AJ De Roos","year":"2003","unstructured":"De Roos AJ, Zahm SH, Cantor KP, Weisenburger DD, Holmes FF, Burmeister LF, et al. Integrative assessment of multiple pesticides as risk factors for non-Hodgkin\u2019s lymphoma among men. Occup Environ Med. 2003;60(9):e11. https:\/\/doi.org\/10.1136\/oem.60.9.e11.","journal-title":"Occup Environ Med"},{"issue":"4","key":"729_CR6","doi-asserted-by":"publisher","first-page":"4449","DOI":"10.3390\/ijerph110404449","volume":"11","author":"L Schinasi","year":"2014","unstructured":"Schinasi L, Leon ME. Non-Hodgkin lymphoma and occupational exposure to agricultural pesticide chemical groups and active ingredients: a systematic review and meta-analysis. Int J Environ Res Public Health. 2014;11(4):4449\u2013527. https:\/\/doi.org\/10.3390\/ijerph110404449.","journal-title":"Int J Environ Res Public Health"},{"issue":"6","key":"729_CR7","doi-asserted-by":"publisher","first-page":"600","DOI":"10.5271\/sjweh.3830","volume":"45","author":"M Pahwa","year":"2019","unstructured":"Pahwa M, Beane Freeman LE, Spinelli JJ, Blair A, McLaughlin JR, Zahm SH, et al. Glyphosate use and associations with non-Hodgkin lymphoma major histological sub-types: findings from the north American pooled project. Scand J Work Environ Health. 2019;45(6):600\u20139. https:\/\/doi.org\/10.5271\/sjweh.3830.","journal-title":"Scand J Work Environ Health"},{"key":"729_CR8","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1016\/j.mrrev.2019.02.001","volume":"781","author":"L Zhang","year":"2019","unstructured":"Zhang L, Rana I, Shaffer RM, Taioli E, Sheppard L. Exposure to glyphosate-based herbicides and risk for non-Hodgkin lymphoma: a meta-analysis and supporting evidence. Mutat Res. 2019;781:186\u2013206. https:\/\/doi.org\/10.1016\/j.mrrev.2019.02.001.","journal-title":"Mutat Res"},{"issue":"8","key":"729_CR9","doi-asserted-by":"publisher","first-page":"2723","DOI":"10.1007\/s00204-017-1962-5","volume":"91","author":"JV Tarazona","year":"2017","unstructured":"Tarazona JV, Court-Marques D, Tiramani M, Reich H, Pfeil R, Istace F, et al. Glyphosate toxicity and carcinogenicity: a review of the scientific basis of the European Union assessment and its differences with IARC. Arch Toxicol. 2017;91(8):2723\u201343. https:\/\/doi.org\/10.1007\/s00204-017-1962-5.","journal-title":"Arch Toxicol"},{"issue":"4","key":"729_CR10","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1002\/ijc.21913","volume":"119","author":"H Besson","year":"2006","unstructured":"Besson H, Brennan P, Becker N, Nieters A, De Sanjos\u00e9 S, Font R, et al. Tobacco smoking, alcohol drinking and non-Hodgkin\u2019s lymphoma: an European multi-Centre case-control study (Epilymph). Int J Cancer. 2006;119(4):901\u20138. https:\/\/doi.org\/10.1002\/ijc.21913.","journal-title":"Int J Cancer"},{"issue":"Suppl 2","key":"729_CR11","doi-asserted-by":"publisher","first-page":"S42","DOI":"10.1093\/ije\/22.Supplement_2.S42","volume":"22","author":"L Miligi","year":"1993","unstructured":"Miligi L, Settimi L, Masala G, Maiozzi P, Alberghini Maltoni S, Seniori Costantini A, et al. Pesticide exposure assessment: a crop exposure matrix. The Working Group on Pesticide Exposure Assessment. Int J Epidemiol. 1993;22(Suppl 2):S42\u20135.","journal-title":"Int J Epidemiol"},{"issue":"2","key":"729_CR12","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1080\/104732201460406","volume":"16","author":"JJ van Hemmen","year":"2001","unstructured":"van Hemmen JJ. EUROPOEM, a predictive occupational exposure database for registration purposes of pesticides. Appl Occup Environ Hyg. 2001;16(2):246\u201350. https:\/\/doi.org\/10.1080\/104732201460406.","journal-title":"Appl Occup Environ Hyg"},{"issue":"2","key":"729_CR13","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1136\/oemed-2012-100845","volume":"70","author":"P Cocco","year":"2013","unstructured":"Cocco P, Satta G, Dubois S, Pili C, Pilleri M, Zucca M, et al. Lymphoma risk and occupational exposure to pesticides: results of the Epilymph study. Occup Environ Med. 2013;70(2):91\u20138. https:\/\/doi.org\/10.1136\/oemed-2012-100845.","journal-title":"Occup Environ Med"},{"issue":"19","key":"729_CR14","doi-asserted-by":"publisher","first-page":"5019","DOI":"10.1182\/blood-2011-01-293050","volume":"117","author":"E Campo","year":"2011","unstructured":"Campo E, Swerdlow SH, Harris NL, Pileri S, Stein H, Jaffe ES. The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications. Blood. 2011;117(19):5019\u201332. https:\/\/doi.org\/10.1182\/blood-2011-01-293050.","journal-title":"Blood"},{"key":"729_CR15","volume-title":"Statistical methods for research workers","author":"RA Fisher","year":"1925","unstructured":"Fisher RA. Statistical methods for research workers. Edinburgh: Oliver and Boyd; 1925."},{"issue":"6","key":"729_CR16","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1002\/ajim.10289","volume":"44","author":"L Miligi","year":"2003","unstructured":"Miligi L, Costantini AS, Bolejack V, Veraldi A, Benvenuti A, Nanni O, et al. Non-Hodgkin's lymphoma, leukemia, and exposures in agriculture: results from the Italian multicenter case-control study. Am J Ind Med. 2003;44(6):627\u201336. https:\/\/doi.org\/10.1002\/ajim.10289.","journal-title":"Am J Ind Med"},{"issue":"1","key":"729_CR17","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1289\/ehp.7340","volume":"113","author":"AJ De Roos","year":"2005","unstructured":"De Roos AJ, Blair A, Rusiecki JA, Hoppin JA, Svec M, Dosemeci M, et al. Cancer incidence among glyphosate-exposed pesticide applicators in the agricultural health study. Environ Health Perspect. 2005;113(1):49\u201354. https:\/\/doi.org\/10.1289\/ehp.7340.","journal-title":"Environ Health Perspect"},{"issue":"9","key":"729_CR18","first-page":"2447","volume":"52","author":"KP Cantor","year":"1992","unstructured":"Cantor KP, Blair A, Everett G, Gibson R, Burmeister LF, Brown LM, et al. Pesticides and other agricultural risk factors for non-Hodgkin's lymphoma among men in Iowa and Minnesota. Cancer Res. 1992;52(9):2447\u201355.","journal-title":"Cancer Res"},{"issue":"2","key":"729_CR19","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1007\/BF00053156","volume":"4","author":"LM Brown","year":"1993","unstructured":"Brown LM, Burmeister LF, Everett GD, Blair A. Pesticide exposures and multiple myeloma in Iowa men. Cancer Causes Control. 1993;4(2):153\u20136. https:\/\/doi.org\/10.1007\/BF00053156.","journal-title":"Cancer Causes Control"},{"issue":"8","key":"729_CR20","doi-asserted-by":"publisher","first-page":"1846","DOI":"10.1002\/ijc.28191","volume":"133","author":"L Kachuri","year":"2013","unstructured":"Kachuri L, Demers PA, Blair A, Spinelli JJ, Pahwa M, McLaughlin JR, et al. Multiple pesticide exposures and the risk of multiple myeloma in Canadian men. Int J Cancer. 2013;133(8):1846\u201358. https:\/\/doi.org\/10.1002\/ijc.28191.","journal-title":"Int J Cancer"},{"issue":"5","key":"729_CR21","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1136\/oem.2008.040972","volume":"66","author":"L Orsi","year":"2009","unstructured":"Orsi L, Delabre L, Monnereau A, Delval P, Berthou C, Fenaux P, et al. Occupational exposure to pesticides and lymphoid neoplasms among men: results of a French case-control study. Occup Environ Med. 2009;66(5):291\u20138. https:\/\/doi.org\/10.1136\/oem.2008.040972.","journal-title":"Occup Environ Med"},{"issue":"25","key":"729_CR22","doi-asserted-by":"publisher","first-page":"6386","DOI":"10.1182\/blood-2009-02-203471","volume":"113","author":"O Landgren","year":"2009","unstructured":"Landgren O, Kyle RA, Hoppin JA, Beane Freeman LE, Cerhan JR, Katzmann JA, et al. Pesticide exposure and risk of monoclonal gammopathy of undetermined significance in the agricultural health study. Blood. 2009;113(25):6386\u201391. https:\/\/doi.org\/10.1182\/blood-2009-02-203471.","journal-title":"Blood"},{"issue":"11","key":"729_CR23","first-page":"1155","volume":"10","author":"HH McDuffie","year":"2001","unstructured":"McDuffie HH, Pahwa P, McLaughlin JR, Spinelli JJ, Fincham S, Dosman JA, et al. Non-Hodgkin's lymphoma and specific pesticide exposures in men: cross-Canada study of pesticides and health. Cancer Epidemiol Biomark Prev. 2001;10(11):1155\u201363.","journal-title":"Cancer Epidemiol Biomark Prev"},{"issue":"1","key":"729_CR24","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1080\/1059924X.2012.632726","volume":"17","author":"CP Karunanayake","year":"2012","unstructured":"Karunanayake CP, Spinelli JJ, McLaughlin JR, Dosman JA, Pahwa P, McDuffie HH. Hodgkin lymphoma and pesticides exposure in men: a Canadian case-control study. J Agromed. 2012;17(1):30\u20139. https:\/\/doi.org\/10.1080\/1059924X.2012.632726.","journal-title":"J Agromed"},{"key":"729_CR25","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1093\/jncimonographs\/lgu013","volume":"48","author":"LM Morton","year":"2014","unstructured":"Morton LM, Slager SL, Cerhan JR, Wang SS, Vajdic CM, Skibola CF, et al. Etiologic heterogeneity among non-Hodgkin lymphoma subtypes: the InterLymph non-Hodgkin lymphoma subtypes project. J Natl Cancer Inst Monogr. 2014;48:130\u201344.","journal-title":"J Natl Cancer Inst Monogr"},{"issue":"11","key":"729_CR26","doi-asserted-by":"publisher","first-page":"2048","DOI":"10.1038\/bjc.1998.341","volume":"77","author":"M Nordstr\u00f6m","year":"1998","unstructured":"Nordstr\u00f6m M, Hardell L, Magnuson A, Hagberg H, Rask-Andersen A. Occupational exposures, animal exposure and smoking as risk factors for hairy cell leukaemia evaluated in a case-control study. Br J Cancer. 1998;77(11):2048\u201352. https:\/\/doi.org\/10.1038\/bjc.1998.341.","journal-title":"Br J Cancer"},{"issue":"6","key":"729_CR27","doi-asserted-by":"publisher","first-page":"1353","DOI":"10.1002\/(SICI)1097-0142(19990315)85:6<1353::AID-CNCR19>3.0.CO;2-1","volume":"85","author":"L Hardell","year":"1999","unstructured":"Hardell L, Eriksson M. A case-control study of non-Hodgkin lymphoma and exposure to pesticides. Cancer. 1999;85(6):1353\u201360. https:\/\/doi.org\/10.1002\/(SICI)1097-0142(19990315)85:6<1353::AID-CNCR19>3.0.CO;2-1.","journal-title":"Cancer"},{"issue":"7","key":"729_CR28","doi-asserted-by":"publisher","first-page":"1657","DOI":"10.1002\/ijc.23589","volume":"123","author":"M Eriksson","year":"2008","unstructured":"Eriksson M, Hardell L, Carlberg M, Akerman M. Pesticide exposure as risk factor for non-Hodgkin lymphoma including histopathological subgroup analysis. Int J Cancer. 2008;123(7):1657\u201363. https:\/\/doi.org\/10.1002\/ijc.23589.","journal-title":"Int J Cancer"},{"issue":"5","key":"729_CR29","doi-asserted-by":"publisher","first-page":"1519","DOI":"10.1093\/ije\/dyz017","volume":"48","author":"ME Leon","year":"2019","unstructured":"Leon ME, Schinasi LH, Lebailly P, Beane Freeman LE, Nordby KC, Ferro G, et al. Pesticide use and risk of non-Hodgkin lymphoid malignancies in agricultural cohorts from France, Norway and the USA: a pooled analysis from the AGRICOH consortium. Int J Epidemiol. 2019;48(5):1519\u201335. https:\/\/doi.org\/10.1093\/ije\/dyz017.","journal-title":"Int J Epidemiol"},{"key":"729_CR30","first-page":"267","volume-title":"IARC Monographs on the Evaluation of the Carcinogenic Risks to Humans. DDT, Lindane and 2,4D","author":"International Agency for research on Cancer","year":"2018","unstructured":"International Agency for research on Cancer. IARC Monographs on the Evaluation of the Carcinogenic Risks to Humans. DDT, Lindane and 2,4D, vol. 113. Lyon: IARC; 2018. p. 267\u2013372."}],"container-title":["Environmental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12940-021-00729-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12940-021-00729-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12940-021-00729-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T16:12:52Z","timestamp":1619626372000},"score":1,"resource":{"primary":{"URL":"https:\/\/ehjournal.biomedcentral.com\/articles\/10.1186\/s12940-021-00729-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,28]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["729"],"URL":"https:\/\/doi.org\/10.1186\/s12940-021-00729-8","relation":{},"ISSN":["1476-069X"],"issn-type":[{"value":"1476-069X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,28]]},"assertion":[{"value":"2 November 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 April 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 April 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Local Ethics Committees approved the study in each of the six study centers.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Obtained.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"49"}}